NABA Senior Compliance Professional

Profile

NABA Senior Compliance Professional

The candidate will provide guidance for the development and implementation of the Medicaid Compliance Program. Will serve as the primary point of contact for all Managed Care Organization (MCO) communications regarding compliance issues. Will ensure that written policies, procedures, and standards are in compliance with requirements set forth in the Contract. Analyze business requirements, provide research and regulatory interpretation, and advise internal business units and external business partners in delivering results in a manner that minimizes compliance risk exposure for the Company. While working within assigned areas to optimize business results, they will maintain key relationships both internally with the operational leaders as well as externally with the business partners, the State Medicaid Office and/or the Centers for Medicare and Medicaid Services (CMS). Interpret and define regulatory and contract requirements to be implemented by appropriate Departments and/or external business partners. Provide on-going oversight and monitoring of all Medicaid business operations to ensure full compliance and minimize risk for the Enterprise. Review and analyze market documents and data to identify what can be used to evidence meeting regulatory standards. Work across the operational units and product lines to enhance data analytics and operational improvement efforts. Coordinate and manage a standard set of data relating to regulatory standards. Perform risk assessments, develop and oversee action plans, and provide guidance to operational groups. Serve as a translator between the business leaders and State and Federal Medicaid Departments assisting with the interpretation of the intention of the guidelines. Coordinate day-to-day interaction with outside regulators as necessary. Act as a key participant in both on and offsite external audits, working with the regulators, as necessary.

Additional Information

Requisition ID: R-249209.

Company info

Humana Inc.
3665 W Waters Ave
Tampa
Florida
United States 33614-2783
Website : http://www.humana.com